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. 2023 Jul 25:36:11321.
doi: 10.3389/ti.2023.11321. eCollection 2023.

The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice

Dennis A J van den Broek  1 , Soufian Meziyerh  1 , Klemens Budde  2 , Carmen Lefaucheur  3 , Emanuele Cozzi  4 , Dominique Bertrand  5 , Covadonga López Del Moral  2   6 , Anthony Dorling  7 , Marie-Paule Emonds  8   9 , Maarten Naesens  9 , Aiko P J de Vries  1 ; ESOT Working Group Subclinical DSA Monitoring
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The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice

Dennis A J van den Broek et al. Transpl Int. .

Abstract

Solid phase immunoassays improved the detection and determination of the antigen-specificity of donor-specific antibodies (DSA) to human leukocyte antigens (HLA). The widespread use of SPI in kidney transplantation also introduced new clinical dilemmas, such as whether patients should be monitored for DSA pre- or post-transplantation. Pretransplant screening through SPI has become standard practice and DSA are readily determined in case of suspected rejection. However, DSA monitoring in recipients with stable graft function has not been universally established as standard of care. This may be related to uncertainty regarding the clinical utility of DSA monitoring as a screening tool. This consensus report aims to appraise the clinical utility of DSA monitoring in recipients without overt signs of graft dysfunction, using the Wilson & Junger criteria for assessing the validity of a screening practice. To assess the evidence on DSA monitoring, the European Society for Organ Transplantation (ESOT) convened a dedicated workgroup, comprised of experts in transplantation nephrology and immunology, to review relevant literature. Guidelines and statements were developed during a consensus conference by Delphi methodology that took place in person in November 2022 in Prague. The findings and recommendations of the workgroup on subclinical DSA monitoring are presented in this article.

Keywords: DSA; biomarker; donor-specific HLA antibodies; guidelines; monitoring; subclinical rejection.

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Conflict of interest statement

KB declares honoraria and or travel support from: Aicuris, Astellas, Astra, CareDx, Carealytics Digital Health, Chiesi, MSD, Neovii, Natera, Paladin, Stada, Takeda, Veloxis, Vifor. AVR received lecture and consultancy fees from Sandoz, Chiesi, Astellas, Hansa, CSL Behring, and Novartis in the past three years, all of which went to his employer and none to personal bank accounts. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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